Cold, Flu or COVID-19? How to Tell the Difference

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Winter months are more likely to bring about frequent respiratory diseases. The situation in 2020 has been complicated by the outbreak of COVID-19. Timely identification and treatment of respiratory conditions especially COVID-19, and other viral illnesses such as cold and flu can better protect our health and that of our love ones.

COVID-19 Diagnostic Approach

It is important to be aware of possible symptomatic and asymptomatic/pre-symptomatic cases of COVID-19. Transmission of COVID-19 from individuals with infection but no symptoms (including those who later developed symptoms and thus were considered pre-symptomatic) has been well documented. The extent to which transmission occurs from asymptomatic or pre-symptomatic subjects and how much it contributes to the pandemic remains uncertain. However, the risk of transmission from an asymptomatic individual appears less than that from a symptomatic individual.

As COVID-19 is prevalent worldwide, clinicians tend to have a low threshold for suspicion of infection, and the likelihood is further increased if the patient:

• Resides in or has travelled within the prior 14 days to a location where there is community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; ie, large numbers of cases that cannot be linked to specific transmission chains); in such locations, residence in congregate settings or association with events where clusters of cases have been reported is a particularly high risk for exposure.

• Has had close contact with a confirmed or suspected case of COVID-19 in the prior 14 days, including through work in health care settings. Close contact includes being within approximately six feet (about two meters) of the individual with COVID-19 for more than a few minutes while not wearing personal protective equipment (PPE) or having direct contact with infectious secretions while not wearing PPE.

Coinfection of COVID-19 and other respiratory pathogens, including influenza viruses have been described. If influenza and other viruses (E.g. Respiratory Syncytial Virus) are circulating in the community, it is reasonable to also test for these viruses when testing for COVID-19 as this could affect treatment.

Symtoms That Warrant Suspicion

There are no specific clinical features that can reliably distinguish COVID-19 from other viral respiratory infections. Cough, muscle pain, and headache are the most commonly reported symptoms. Other features, including diarrhea, sore throat, and smell or taste abnormalities, are also well described. Some features may warrant a higher level of clinical suspicion.

Smell or taste disorders are more common with COVID-19 than with other viral respiratory infections. Development of dyspnea several days after the onset of initial symptoms is suggestive of COVID-19. In one study of health care workers (mainly women aged 20 to 40 years) who were tested for COVID-19 because of consistent mild symptoms, loss of sense of smell and muscle pain were most strongly associated with a positive test. Other, more unusual findings, such as new onset pernio-like lesions (E.g. "COVID toes"), also heighten suspicion for COVID-19. 

Symptoms

There are lots of similarities between illness presentation from the coronavirus and influenza, but there are some differences that help doctors distinguish them. However, none of these findings can definitively establish the diagnosis of COVID-19 without microbiologic testing.

A key difference is the incubation period for the viruses - that is, the time it takes to develop symptoms after exposure to it. The flu always strikes quickly, typically one to three days. The incubation period for COVID-19 is generally within 14 days following exposure, with most cases occurring approximately four to five days after exposure. It is important to self-isolate immediately after being exposed so as not to unknowingly infect others. People usually recover from the influenza in five to seven days. The time to recovery from COVID-19 is highly variable and depends on age and pre-existing conditions in addition to illness severity. Individuals with mild infection are expected to recover relatively quickly (E.g. within two weeks) whereas many individuals with severe disease have a longer time to recovery (E.g. two to three months). Some common persistent symptoms include fatigue, shortness of breath, chest pain, cough, and cognitive deficits.

As mentioned, symptoms themselves are difficult to distinguish. Below is a list of 14 symptoms that are easily confused among coronavirus, influenza, common cold and allergies. Please note that your symptoms may vary, and information regarding COVID-19 is still evolving. If you're worried, it is recommended that testing be done.

Notes that allergies, colds and influenza can all trigger asthma, which can lead to shortness of breath. COVID-19 is the only one associated with shortness of breath on its own. 

Patients with suspected COVID-19 who do not need emergency care should be encouraged to call prior to presenting to a health care facility for evaluation. Many patients can be evaluated regarding the need for testing over the phone. For patients in a health care facility, infection control measures should be implemented as soon as the possibility of COVID-19 is suspected.

Sources: Asthma and Allergy Foundation of America, World Health Organization, Centers for Disease Control and Prevention.

Testing for COVID-19

During a pandemic, COVID-19 cannot be ruled out based upon clinical history. It is thus important to consider testing yourself for COVID-19 if there are increased suspicion of COVID-19 infection.

Nucleic acid amplification testing (NAAT), most commonly with a reverse-transcription polymerase chain reaction (RT-PCR) assay, to detect SARS-CoV-2 RNA from the upper respiratory tract is the preferred initial diagnostic test for both acute symptomatic and asymptomatic COVID-19 infections. In some settings, antigen testing may be the initial test used, but the sensitivity of antigen tests is lower than that of NAATs, and negative antigen tests should usually be confirmed with NAAT.

Further information about who should be tested are available below:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html

Chengdu Gleneagles Hospital COVID Test

Located right next to the East Railway Station, Gleneagles Hospital Chengdu has won the trust and praise of patients for its high-quality clinical care, exceptional standards, guaranteed safety, and impeccable all-around care.

The price for a COVID-19 NAAT at Gleneagles Hospital is 193RMB, and you can get the report 48hrs afterwards.

Address: 

Building A2, No. 5333, Jinxiu Road (west plaza of East Railway Station), Chenghua District

成都市成华区锦绣大道5333号A2座（近东站西广场）

Phone number: 

028-60216666

Time:

Mon. - Fri. , 08:00-17:00 (except holidays)

Website: 

http://www.gleneagleschengdu.com

More information: 

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To book an appointment at 

Gleneagles Hospital, please call 028-60216666, 

or scan the WeChat QR below.  

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